Easy to understand, for critical care nurses and student to know basic about ACS.

1. Acute Coronary Syndrome
Prepared by:
Feroz khan
Sr. Clinical Nurse

2. Out Comes
1. To be able to differentiate heart attack and
muscular pain.
2. To understand about Acute Coronary
Syndrome.
3. To understand differences between unstable
angina vs NSTEMI vs STEMI.
4. To know risk factors and diagnostic tolls.
5. To know about treatment and management.

3. Acute Coronary Syndrome
“A spectrum of conditions resulting from
thrombus formation in the coronary arteries
following rupture of an atherosclerotic plaque”

4. Types of ACS
NSTEMI
ACS
STEMI
UA

5. Acute Coronary Cyndrome (ACS)
UN Unstable Angina
NSTEMI Non ST Elevation
Myocardial Infarction
STEMI ST elevation Myocardial
Infarction

6. Pathalogy
Aorta
Back flow towards
aortic valve during
diastole gives
coronary
perfusion

7. Pathology
Right Coronary
Artery (RCA)
 RA
 SA+AV nodes
 RV
Left Anterior
Descending(LAD)
 LV
 Intra
Ventricular
septum
 RV
Left Coronary
artery(LCA)
Left
circumflex(LCX)
 LA
 LV
Left Obtuse
Marginal(OM)
 LV

8. Pathology
Over time these arteries become
Atherosclerosis.
Which is the formation of fatty plaques on the
walls. Atherosclerosis plaques have a fibrous cap
which contains thrombogenic material;
Cell debris, lipids and inflammatory cell.

9. Pathology
Thrombogenic
Material (cell
debris, lipids,
inflammatory
cells
Fibrous Cap

10. Pathology
Atherosclerosis
Stable Angina
Acute reduced
blood flow
Clot formation
Ruptured
Fibrosis cap

11. Pathology
Severity of obstruction / Ischemia determines ACS
pathology
Unstable Angina NSTEMI STEMI
*No Necrosis *Partial Necrosis *Transmural
(Transmural: Existing or occurring across the entire wall of an organ or blood vessel).

12. Risk factors
Modifiable
1. Smoking
2. Hypertension
3. Diabetes
4. Hyperlipidemia
5. Obesity
6. Drug use eg; Cocaine
Non-Modifiable
1. Age
2. Male sex
3. Family History
4. Ethnicity

13. Signs and Symptoms
i. Chest pain /
Discomfort
ii. Back / Epigastric pain
iii. Light headiness
iv. Nausea /Vomiting
v. Diaphoresis
(Sweating)
vi. Palpitation
vii. Dyspnea
# It is possible to present
without chest pain
Female
Elderly
Diabetics

14. Diagnosis
1) ECG
STEMI
ST elevation
oST elevations ≥ 1mm IN 2 continuous leads
oIf In V2 + V3: ≥ 1.5mm IN Females
≥ 2mm IN Males
o New LBB

15. Diagnosis
1. 12 leads ECG
Anterior/Septal Lateral Interior
Left anterior Descending Left circumflex Right coronary

16. Diagnosis
1. 12 lead ECG
NSTE-ACS( NSTEMI+UA)
ST wave
ST Depression Inversion
 ST depression + T wave inversion
 Not representing of location
 Pathological Q wave not typical
 Isolated TWI are Post Ischemic

17. Diagnosis
1. 12 lead ECG
LBBB
*ST segment difficult to
interpret in LBBB
OR Paced Rhythm

18. Diagnosis
1. ECG
2. LAB investigations
– Cardiac Troponin I
– ≥ 99 Pecentile
– Rise from 2hrs
– Peak at 12-48 hrs

19. Diagnosis
1. ECG
2. LAB investigations
3. Coronary Angiography
4. C x R
5. Echocardiography

20. Treatment
General
– Morphine
– Oxygen
– Nitrates
– spirin
– Anti Emetics
Perfusion/
Reperfusion
– STEMI / High Risk
– Primary Percutaneous
intervention (≤ 90minutes)
– Fibrinolytics
• Tissue plasminogen activator
Eg : Altiplase
Rectiplase etc

21. Treatment
Medical
1. Anti Platelets
*P2Y12 Inhibators
eg; Ticagrelor/ clopidogril
2. Anti Coagulation
*IV Heparin
* SC LMWH (Low molecular heparin)
3. STATIN
4. ACEi / ARB
5. Beta Blocker

22. Nursing Interventions
Nurses caring for patients with ACS should have ;
ECG interpretation skills, as ECG changes or arrhythmias are signs
of potential deterioration.
Other elements of nursing care include ongoing management of
IV cannulas, central venous pressure lines, urinary catheters and
wounds and dressings.

23. It is the nature of the strong heart, that like the
palm tree it strives ever upwards when it is most
burdened. ...
Philip Sidney